About a year ago, the FDA released findings that fluoroquinolone antibiotics can cause dangerous side effects involving the tendons, muscles, joints, nerves and central nervous system, and advised that use should be restricted in uncomplicated situations.
However, the FDA has reviewed all reports and updated their safety warning. Although some negative side effects are still possible, the FDA does not believe that fluoroquinolone antibiotics can result in detachment of the retina, or tears in the aorta blood vessel.
At this time, the FDA has determined that fluoroquinolone antibiotics should be avoided, if possible, in the following infections: acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infections. Your doctor may prescribe a fluoroquinolone antibiotic for one of these infections if there are no other treatment options available for you. Be sure to speak with your doctor about the possible side effects.
What are fluoroquinolone antibiotics?
Fluoroquinolone antibiotics include Cipro (ciprofloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Factive (gemifloxacin), and ofloxacin. These drugs are typically used to treat urinary tract infections, sinus infections, respiratory infections, typhoid, and pneumonia.
What side effects are related to fluoroquinolone antibiotics?
If you have been prescribed a fluoroquinolone antibiotic be sure to seek medical attention if you experience any side effects like unusual joint or tendon pain, muscle weakness, tingling or pricking sensation, numbness in arms or legs, confusion or hallucinations.
What has been done to warn people about these serious side effects?
Drug manufacturers of all fluoroquinolone antibiotics are required to update their boxed warning and patient medication guides to reflect the side effects. The FDA will continue to assess the safety issues with fluoroquinolone antibiotics.
Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections have been catastrophic for patients—they result in longer hospital stays and poorer outcomes. More than 80% of the time, infections result because of Staph aureus that we are carrying, in our nose or on our skin.
For those of us who may be carriers of Staph aureus (it lives in our nose)—does attempting to decolonize our nose with Bactroban (mupirocin) antibiotic ointment help prevent these infections after surgery? Let’s find out.
First, know that in most studies about 10 – 18% of us will have a positive nasal swab for Staph aureus, meaning we are a carrier of that bacteria in our noses.
The medical community has spent the last few years trying to answer whether Bactroban 2% ointment used twice a day for 5 days in your nostrils prior to surgery prevents surgical site infections. How this works: during your pre-operative visit a nasal screening swab is done and if you are positive for S. aureus you are treated with 5 nights of ointment in your nose before your surgery. So should we do it before all surgeries?
Hip and knee replacement surgeries:
Here, the data is the most convincing. For reducing infections after hip and knee replacement, the answer appears to be yes. If your nasal swab is positive for S. aureus, treatment with Bactroban for 5 days before surgery has been shown to decrease surgical site infections by 69%.
Which other surgical patients get the most benefit from pre-screening and treatment?
Cardiovascular or vascular procedures with implantation of prosthetic grafts and orthopedic joint procedures. The benefit of Bactroban in other device-related surgical procedures like hernia mesh is unknown and currently not supported by the medical/surgical literature.
Does it lower risk of death along with lower surgical site infection risk?
In a large study using Bactroban ointment and chlorhexidine wipes, the authors found that treatment prior to surgery (in those whose nasal swabs were positive) reduced infections by 60%. The bonus here was that longer-term follow up also noted decreased mortality in those screened and treated. Detection and decolonization of Staph aureus not only prevents surgical-site infections but also reduces 1-year mortality in some surgical patients (Bode, NEJM Jan 2010).
What do I use?
The best regimen to decolonize your nose and skin of Staph aureus isn’t clear. The current recommendation is nasal Bactroban twice a day for 5 days. To decolonize the skin, some also recommend using 2% or 4% chlorhexidine gluconate (also known as Hibiclens) body cleansing once a day for 2 – 3 days prior to surgical admission.
How do I use it?
Bactroban (mupirocin), one gram in each nostril, twice a day for 5 days. It’s a prescription that comes in prepacked tubes (a pack of 10, each with 1 gram). You should know though, it’s much cheaper to get a tube (22 grams) of Bactroban ointment and estimate a gram in each nostril. One gram is two finger tip units, so squeeze along your fingertip to estimate.
Take home message:
While there is some debate, hospital-acquired infections with S. aureus in surgical patients can be prevented by screening to see if you are a carrier—and treating with Bactroban nasal ointment if S. aureus is found.
Last week, GoodRx rolled out exclusive new savings on more than 40 brand-name prescriptions, and we also promised to pursue discounts for more drugs.
Today, we’re happy to announce new Inside Rx discounts for 6 more brands:
- Colcrys (treats gout): 45% off retail price
- Uloric (treats gout): 16% off retail price
- Amitiza (treats constipation): 40% off retail price
- Dexilant (treats GERD): 40% off retail price
- Trintellix (treats depression): 24% off retail price
- AirDuo Respiclick (treats COPD): just released so no comparison available yet
Like all GoodRx coupons, these new discounts are easy to use—just search for your drug and print out the discount. There are no fees, forms, paperwork, or sign-ups required. These discounts work at most major pharmacy chains.
A reminder—if you have insurance, you may also want to consider manufacturer co-pay programs. Just click on the Savings Tips link after you search for a drug to see which option will save you the most. On the Savings Tips page, we also list patient assistance programs and other valuable savings tips.
Keep in mind, there are a few restrictions attached to these discounts (learn more here).
We know that many other brand-name drugs are still too expensive, and we are continuing to expand the Inside Rx program. We’ll be adding more drugs and discounts soon. If you take a prescription that is too expensive, email us at email@example.com, and we’ll make finding a lower price for your prescription a priority.
On April 21st, the FDA approved Renflexis (infliximab-abda), the second biosimilar to the popular medication Remicade, (infliximab) indicated for immune disorders.
A biosimilar is like a generic medication in that it is less expensive than the brand name medication. However, the difference is that biosimilars are made out living cells, so they may be slightly different from their counterpart. This usually means that the pharmacist will not substitute these medications without approval from a doctor. For more information on what a biosimilar is, read our previous blog post here.
What is Renflexis indicated for?
Renflexis is indicated for multiple conditions including crohn’s disease, pediatric crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis.
How is Renflexis to be used?
Renflexis will be available as an intravenous infusion in a strength of 100mg/20ml. Your dose of Renflexis will be determined by your doctor based on your weight and your specific condition. It is to be administered by your doctor at his or her office as an intravenous infusion over a period of no less than 2 hours.
Renflexis is considered a specialty medication, which means that it will most likely be delivered to your home or readily available at a designated specialty pharmacy.
What are the most common side effects associated with Renflexis?
The most common side effects include infections, infusion-related reactions, headache and abdominal pain. More serious side effects include more life-threatening infections or cancer.
What other biosimilars for Remicade exist?
Renflexis should be available in pharmacies in about six months.
Repetitive involuntary movements typically affecting the jaw, lips, tongue, arms or legs can be caused by tardive dyskinesia, a neurological disorder. Tardive dyskinesia is often seen as a side effect in patients taking antipsychotic medications used to treat certain mental illnesses.
Previously, no medications were FDA approved to specifically treat tardive dyskinesia, making prevention key. This meant that the only way help patients with tardive dyskinesia were to change their antipsychotic medication, or stop it all together, which could be harmful to patients who required treatment.
However, there is now good news for patients suffering from Tardive Dyskinesia, the FDA just approved Ingrezza. This is the first drug approved by the FDA for this condition.
What is Ingrezza indicated for?
Ingrezza is indicated for the treatment of adults with tardive dyskinesia, a side effect of medications used to treat certain psychiatric or stomach conditions. Tardive dyskinesia can cause repetitive involuntary movements like sticking out the tongue, lip smacking, facial grimacing, movement of the arms and legs, or shallow breathing.
Tardive dyskinesia can be caused by antipsychotic drugs like chlorpromazine (Promapar, Thorazine), fluphenazine (Prolixin, Permitil), haloperidol (Haldol), perphenazine (Trilafon), prochlorperazine (Compazine, Compro, Procomp), thioridazine (Mellaril) and trifluoperazine (Stelazine). Tardive dyskinesia can also be caused by the stomach medication, metoclopramide (Reglan, Metozolv).
How should Ingrezza be taken?
Ingrezza will be available as a capsule in a strength of 40 mg. For the initial dose, patients should take one 40 mg capsule by mouth once daily for one week. After one week, the dose should be increased to the recommended dose of two 40 mg capsules once daily. Ingrezza can be taken with or without food.
How can I save on Ingrezza?
Manufacturer Neurocrine Biosciences has created the Inbrace Support Program to help patients afford Ingrezza. You will need your doctor to fill out the enrollment form, and then eligible patients can save up to 100% on each prescription. You can read here for more information about the Ingrezza savings program.